MedicaidPrior AuthMedium impact
Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)
Humana·SC · Rheumatology, Gastroenterology, Dermatology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid in South Carolina has established prior authorization requirements for Inflectra (infliximab-dyyb), a biosimilar to Remicade, for treating various conditions including rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis. The policy outlines specific criteria that must be met for each indication, including age requirements, prior therapy failures, and exclusions for combination biologic therapy.
Action Required
Immediately: Billing team must obtain prior authorization for all Inflectra (infliximab-dyyb) infusions for South Carolina Medicaid patients. Verify patients meet specific criteria for their diagnosis including age requirements, prior therapy failures, and ensure no combination biologic therapy exclusions apply. Update billing system to flag these cases for prior auth before scheduling treatments.